Comparison of narrow versus standard target INR ranges

Meier, David; Sonnad, Seema S.; Merz, Julie; Fay, William P.

doi:10.1016/s0735-1097(02)81220-7

Cited by 4 publications

(5 citation statements)

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“…The TTR in the lower and narrower TR of 2.0–2.5 and the higher TR of 3.5–4.5 (5.0) were significantly lower compared with the TTR in children with a TR of 2.0–3.5. This is in line with the findings of previous studies in adults . The study by Meier et al .…”

Section: Discussionsupporting

confidence: 94%

“…The study by Meier et al . showed that a narrow TR of 2.0–2.5 led to more INRs below 2 compared with a TR of 2.0–3.0 . Gadisseur et al .…”

Section: Discussionmentioning

confidence: 99%

“…age and genetic composition) and the management of VKA therapy (patient self‐testing, patient self‐management [self‐testing and self‐dosing], management by an anticoagulation clinic or general care strategies) . Moreover, other factors play a role, such as the method of calculating the TTR, the type of VKA, if the TTR includes the initiation period of the VKA or not and the predefined therapeutic INR range (TR) .…”

Section: Introductionmentioning

confidence: 99%

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Characteristics and quality of oral anticoagulation treatment in pediatric patients in the Netherlands based on the CAPS cohort

Maagdenberg

Bierings

Ommen

et al. 2018

Journal of Thrombosis and Haemostasis

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To cite this article: Maagdenberg H, Bierings MB, van Ommen CH, van der Meer FJM, Appel IM, Tamminga RYJ, de Boer A, Maitland-van der Zee AH. Characteristics and quality of oral anticoagulation treatment in pediatric patients in the Netherlands based on the CAPS cohort. 2018; 16: 116-24. J Thromb Haemost Essentials• The knowledge of quality and safety of acenocoumarol and phenprocoumon use in children is limited.• We used data from a multicenter retrospective followup study in children in the Netherlands.• The quality of anticoagulation control in the first month of use was low, but improved thereafter.• No thromboembolic events occurred, however bleeding events occurred in 1-3 out of 10 patients.Summary. Background: The use of vitamin-K antagonists in pediatric patients is rare and information on the quality and safety of treatment with acenocoumarol and phenprocoumon is limited. Objectives: To assess the quality, safety and effectiveness during the first year of acenocoumarol and phenprocoumon treatment in pediatric patients in the Netherlands. Methods: The Children Anticoagulation and Pharmacogenetics Study (CAPS) was designed as a multicenter retrospective follow-up study. Patients who used acenocoumarol or phenprocoumon at an age of ≤ 18 years, were selected from four pediatric hospitals and one anticoagulation clinic in the Netherlands. The quality of treatment was assessed by calculating the percentage of time in therapeutic INR range (TTR) for the first month and for every 3 months of use during the first year of treatment. Effectiveness and safety were assessed by the number of thromboembolic and bleeding events. Results: In total, 213 patients participated, of whom 187 (155 acenocoumarol; 32 phenprocoumon) were included in this analysis. The mean TTR was 47.0% and 51.4% in the first month of use for acenocoumarol and phenprocoumon, respectively. After the first 3 months the mean TTR for both VKAs was above 64%. In 14.6% (acenocoumarol) and 31.3% (phenprocoumon) of the patients a bleeding event occurred during the first year of treatment; no thromboembolic events were reported. Conclusions: The quality of anticoagulation treatment was low during the first month of use and leaves room for improvement. After the first month it increased to an acceptable level. However, bleeding events occurred frequently during the first year.

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Section: Discussionsupporting

confidence: 94%

“…The study by Meier et al . showed that a narrow TR of 2.0–2.5 led to more INRs below 2 compared with a TR of 2.0–3.0 . Gadisseur et al .…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Characteristics and quality of oral anticoagulation treatment in pediatric patients in the Netherlands based on the CAPS cohort

Maagdenberg

Bierings

Ommen

et al. 2018

Journal of Thrombosis and Haemostasis

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“…The time within therapeutic range was calculated using the method of ‘The fraction of INRs in the range’, which was calculated by taking total number of INRs within therapeutic range for all patients divided by the total number of INRs checked during the selected time interval i.e., 6 months period. [14] All the patients, after discharge, were followed-up during the entire period of study through telephonic contacts on a weekly basis. The patients were free to call the clinical pharmacist for clarification of any anticoagulation related issues between 8 am and 8 pm thorough an on call mobile allocated by the hospital administration for the AMS.…”

Section: Methodsmentioning

confidence: 99%

Study on Impact of Clinical Pharmacist′s Interventions in the Optimal Use of Oral Anticoagulants in Stroke Patients

2013

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Anticoagulants are very useful medications but can also lead to haemorrhagic as well as thromboembolic complications when not used correctly or without proper medical attention. Anticoagulant’s complex pharmacology and pharmacokinetics contribute to its narrow margin of safety. Pharmacist’s unique knowledge of pharmacology, pharmacokinetics and interactions makes them well-suited to assist patients in maintaining safe and effective anticoagulation. Successful anticoagulation therapy implies fewer incidences of therapeutic failures and bleeding complications. The anticoagulation management service staffed by clinical pharmacists is a service established to monitor and manage oral and parenteral anticoagulants. In this research work, 40 patients each were included in the intervention and the control groups. In the intervention group, patient’s knowledge score on anticoagulation increased from an average of 5.6±3.2 to 13.8±0.94 (P=0.000) after clinical pharmacist’s counselling, whereas in the control group there was no significant improvement in patient’s baseline knowledge over the knowledge score at the end of the study (8.0±1.59 vs. 8.3±2.6) (P=0.218). In the intervention group, 73.45% of the international normalised ratio test results were within the therapeutic range, 8.45% supratherapeutic and 18.5% subtherapeutic during the 6 months data collection period. The corresponding data for the control group were 53.2 (P=0.000), 18.4 (P=0.000) and 28.4% (P=0.002), respectively. Forty four adverse drug reactions (ADRs) related to anticoagulants were identified in the intervention group as compared to 56 in the control group. These results revealed that the clinical pharmacist’s involvement in the anticoagulation management improved the therapeutic outcome of patients and demonstrate the benefits of clinical pharmacist guided anticoagulation clinics in India.

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“…Each approach has its advantages and disadvantages. 219 The results of all of these methods depend on whether an exact or an expanded therapeutic range is used, 221 whether patients just beginning therapy are included or only patients who are already on established therapy are included, 222,223 whether INRs obtained during invasive procedures when warfarin therapy might be interrupted are included, and whether different oral anticoagulant preparations (eg, warfarin, phenprocoumon, or acenocoumarol) are included. [223][224][225] Since clinical outcome studies compar-ing one methodology over another and their correlation with adverse events have not been done, no specific method can be recommended, and the reader should be aware of these differences.…”

Section: Risk Factors or Determinants For Adverse Eventsmentioning

confidence: 99%